Social inequalities in dementia : A register study on dementia morbidity, mortality and long-term care
Year: 2022
Type: dissertation
Study design: Observational Study
Abstract: Social inequalities in health in older age are well recognised in terms of various aspects of disease and disability. Despite improvements in population health, population ageing is projected to be accompanied by increasing prevalence of chronic diseases, especially Alzheimer’s disease and other types of dementia. Although dementia is already one of the leading causes of death and the single most important cause of residential long-term care (LTC), no comprehensive understanding exists about the social patterning of dementia mortality and residential LTC. To tackle the increasing burden of dementia and to address the inequalities in the way disease and disability are distributed in the ageing populations, better insight is needed about how social factors along the life course affect the risk of dementia and care needs at older ages. This study investigates social inequalities in dementia morbidity, mortality and residential LTC among Finnish older cohorts between 2000 and 2018. The aim of the study was to analyse the association between several indicators of socioeconomic position and dementia mortality, and estimate the contribution of dementia to overall socioeconomic inequalities in mortality in older age. A further aim of the study was to analyse how social factors are associated with the use of residential LTC over the years before dementia-related death. Given the long induction times in dementia, the study also focussed on childhood and adulthood social determinants of dementia morbidity and their interplay with health-related risk factors, including depression and cardiovascular health. The study used large individual-level register data on population-representative samples compiled by Statistics Finland and linked with several administrative health registers. Records of causes of death, medication reimbursements and hospital care episodes were used to identify dementia. Dates in residential LTC were obtained from records of health and social care. The results showed that people with a lower midlife socioeconomic position were at an increased risk of dementia-related death. The findings support the idea that educational and occupational social class inequalities relate to differences in cognitive reserve. Inequalities in terms of household income, by contrast, reflected the accumulation of health-related risk factors among the economically more disadvantaged. The inequalities endured with age and, consequently, dementia substantially contributed to the overall socioeconomic inequalities in mortality in older age. Social differentials were also present in living arrangements among people who eventually died with dementia; in the eight years preceding death, older and non-married individuals in particular, but also those with lower income, were more likely than others to live in residential LTC. These differences, however, diminished as death approached, demonstrating that social and economic resources cannot compensate for the intensifying need for care of people with dementia at the end of life. People with a history of clinical depression in earlier life experienced an increased risk of dementia. The increased risk affected people at all levels of education and was not explained by family background shared by siblings. The results indicated that men were at particular risk because of comorbidities – especially alcohol-related conditions. The findings further showed that disadvantaged circumstances already in childhood were associated with dementia morbidity in older age. An excess risk of dementia was related to having lived in crowded households, with a single father, and in the eastern and northern parts of Finland. These associations were only partly attributable to attained socioeconomic position and cardiovascular health in adulthood, suggesting that the accumulation of risk begins already in early life and preventive interventions in midlife may not suffice to reduce the excess risk associated with disadvantaged childhood circumstances. The findings demonstrate that social factors across the life course structure the life chances of individuals and generate important inequalities in health and the ability to continue independent living in older age. The increasing individual and societal burden of dementia in particular highlights the need to address social inequalities in dementia morbidity, mortality and LTC. Further investigations should also assess the effectiveness of socioeconomic and mental health interventions as part of dementia prevention strategies.
Source: Työväentutkimus Vuosikirja
Author: Korhonen, Kaarina
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W6987186530